Medullary plasma pharmacokinetics of vancomycin after intravenous and intraosseous perfusion of the proximal phalanx in horses.
Authors: Rubio-Martínez Luis, López-Sanromán Javier, Cruz Antonio M, Santos Martín, San Román Fidel
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Vancomycin Delivery to the Equine Proximal Phalanx When treating deep infections of the distal limb, such as septic arthritis or osteomyelitis involving the proximal phalanx (P1), regional limb perfusion (RLP) with vancomycin offers high local antibiotic concentrations whilst minimising systemic exposure. Rubio-Martínez and colleagues compared intravenous (IV) and intraosseous (IO) routes for delivering vancomycin to P1 medullary tissue in six horses per group, sampling plasma from the medullary sinusoids at intervals up to 90 minutes post-infusion to measure drug concentrations. Both routes achieved sustained vancomycin levels well above the minimum inhibitory concentration for methicillin-resistant *Staphylococcus aureus* (MRSA) throughout the study period, with no statistically significant difference in peak concentrations or pharmacokinetic profiles between IV and IO administration, and notably, neither approach caused clinical side effects such as lameness or swelling. For practitioners planning RLP protocols for resistant bone or joint infections in the distal equine limb, this finding provides reassurance that choice of perfusion route can be guided by practical considerations rather than efficacy concerns—IO perfusion may therefore be preferred when establishing IV access is challenging, without compromising antimicrobial delivery to the target tissue.
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Practical Takeaways
- •For treating proximal phalanx bone infections, IV and IO regional limb perfusion with vancomycin are interchangeable options—choose based on clinical feasibility and operator preference rather than efficacy concerns
- •Both routes reliably achieve therapeutic drug concentrations in the medullary cavity, so either technique can be confidently used in practice
- •The 90-minute monitoring period suggests both routes maintain effective levels throughout a standard perfusion procedure
Key Findings
- •Both intravenous and intraosseous regional limb perfusion achieved high vancomycin concentrations in proximal phalanx medullary sinusoids that remained above MRSA minimum inhibitory concentration for 90 minutes
- •IV and IO routes produced equivalent pharmacokinetic variables with no significant differences in vancomycin concentration profiles
- •No clinical side effects (lameness or swelling) were observed with either perfusion route